Doctor Name: | RONALD LYNN WAGNER |
NPI Number: | 1366460875 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 4268 |
Business Practice Address: | 511 Elm Ave Linton Medical Center Linton, ND - 58552 |
Business Phone Number: | 7012544531 |
Business Fax Number: | 7012545459 |
Mailing Address: | 430 N Broadway St, LINTON |
State: | ND |
Postal Code: | 58552 |
Phone Number: | 7012544501 |
Fax Number: | 7012545459 |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 4268 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |